reactivating the blogspot.

Mebendazole associated with transient urinary retention

saw a case this am of 24 hrs post vermox - urinary retention in a 17yr old that eased over a 24 hr period

cases in literature

reflection - history of any medication taken before symptom, awareness, literature search

impact - awareness of SE

Business plan - mind dump of ideas/hyperlinks - work in progress

This is NOT a CCG/NHS/PPG/STP/Locality business plan or any tosh like that, expressly this is a hard nosed business plan describing the aim of the plan and the necessary ingredients of such, how they interact with health from a business perspective will be commented upon but the main driver for this is Business.

charles dickens - mr macawber;
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Mr Micawber's famous, and oft-quoted, recipe for happiness:

"Annual income twenty pounds, annual expenditure nineteen [pounds] nineteen [shillings] and six [pence], result happiness. Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery."

Charles Dickens, David Copperfield

oscar wilde cost vs value:
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In Lady Windemere’s Fan, Oscar Wilde had Lord Darlington quip that a cynic was ‘a man who knows the price of everything and the value of nothing.‘ 


turnover vs profit:
-------------------------

Turnover is the net sales generated by a business, while profit is the residual earnings of a business after all expenses have been charged against net sales. Thus, turnover and profit are essentially the beginning and ending points of the income statement - the top-line revenues and the bottom-line results.

having external staff foisted upon a business by a third party with renumeration increases turnover but not profits - the liability for redundancy costs etc becomes yours not the 3rd parties responsibility unless they are employed by the third party and seconded to you

reputation/brand/succession;
------------------------------------

like all business - brand and reputation = success, however if you are part of a subcontracted chain ie macdonalds the monoploy describes the repute/brand but you hold the liabilities - be careful to understand internal brand/repute vs external brand/repute.

bupa costings from danny;
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PbR tarrif hyperlink :
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https://improvement.nhs.uk/resources/national-tariff-1719/#h2-tariff-documents

Staff pay/salaries etc
----------------------------

http://www.firstpracticemanagement.co.uk/knowledge-base/gp-practice-staff-pay-and-ratios-survey/

agenda for change pay scales;
------------------------------------

https://www.rcn.org.uk/employment-and-pay/nhs-pay-scales-2016-17

https://www.healthcareers.nhs.uk/about/careers-nhs/nhs-pay-and-benefits/agenda-change-pay-rates

CQRS data extraction [national pot]
--------------------------

https://digital.nhs.uk/article/279/General-Practice-GP-collections

The Guernsey option [Jonathan Reggler].
----------------------------------------------------

Dr Bob Hodges doc-store link to it;

https://www.doctors.net.uk/DocStore/DSView/Document.aspx?docid=774071

National LES list;
-----------------------
Thanks to Essex LMC;

http://www.essexlmc.org.uk/wp-content/uploads/2013/11/CompleteLESBooklet.pdf

ownership of Citizens/patients
--------------------------------------
the perennial their your patients via CCG or there my/our patients by Drs, is illusory nonsense.
in a socialized healthcare service the ownership of providing a service rests with the SoS for health and their delegated officers - aka commissioners. A providers remit is merely to provide what is agreed in contract - all services outside contract is the commissioners gig or the citizens gig. Patients are not owned by drs, Drs merely own the accountability to be responsible within contract to portray their craft, true ownership rests with commissioners, do not allow this to be foisted upon providers.

Local LES/NES/DES/LCSF stuff hyperlinked
-------------------------------------------------------
buggeration its on an intranet- ill get spec and renumeration and post as cut 'n paste


CQC- aRGHHHHHH
----------------------------

Care Quality Commission (CQC) fees for registered providers 2017/18

10 March 2017

At the end of last year we carried out a public consultation regarding the increase in the fees that providers of health and adult social care in England will be charged from April 2017. I am writing to let you know that these changes have now been confirmed and are outlined on the fees page of our website, which also contains our response to the consultation and supporting information and guidance. The changes are to ensure that we can continue to register, monitor, inspect and rate services to make sure people receive care that is safe, effective, compassionate and high quality and we encourage services to improve.

I would like to thank everyone who took part in the consultation for your valuable contributions, which were all taken into consideration. We are fully aware that the increases agreed are not in line with what many of you would have desired and we acknowledge the strength of the feelings you expressed about the continued fee increases.

CQC is making savings over the period to 2019/20. In 2015/16 our budget was £249 million. The CQC budget for 2019/20 will be £217 million; a reduction of £32 million. During 2016/17 we have made over £10 million in efficiency savings and we are also moving towards fully recovering the chargeable costs of regulating health and adult social care.

The public are entitled to health and care which is safe, effective, high-quality and compassionate. CQC provides the public with independent assurance that services are operating in their interests. All providers of health and adult social care in England must be registered with CQC in order to provide services and the fee paid by providers is the charge for being registered with, and regulated by, CQC.

You can find the annual fee for your service for 2017/18 using the fees calculator published on our website. You can also find guidance on how and when to pay your fees, including information on paying by instalment.

In addition to the fee increases, we will also change two definitions in our fees scheme as set out in our consultation:

• Providers of substance misuse treatment services will be reclassified as providers of healthcare activities, rather than providers of care activities
• Providers of single-location NHS primary medical services, where all or part of that location is a minor injuries unit or an urgent care centre, will be charged on the same basis as single-location providers of NHS primary medical services where all or part of that location is a walk-in-centre.                                              

The amounts providers will pay for their regulation will vary based on the type of health or social care offered, as well as how close the provider is to meeting the chargeable costs of their regulation in full. Examples of the changes providers can expect to their fees in 2017/18 include: 

• £163 increase for a care home with 26-30 residents to £4,375 a year
• £823 increase for a single-location community social care provider (such as a home-care agency) to £2,192 a year
• £65,375 increase for a NHS trust with an income of £125 million to £225 million to £202,239 a year
• £1,952 increase for a single-location GP practice with 5,001-10,000 patients to £4,526 a year
• £113 decrease for a single-location dental practice with four chairs to £837 a year.

Our fees for 2017/18 represent 0.16% of overall indicative turnover of the health and social care market.

We would like to thank you for your continued support and involvement in working with us.

Yours sincerely,

Sir David Behan CBEChief ExecutiveCare Quality Commission

STPs and Gosplan

ring any bells ?

https://en.wikipedia.org/wiki/Soviet-type_economic_planning

where did 5 yr plans come from?

https://en.wikipedia.org/wiki/Gosplan

Epigenetics

https://youtu.be/kp1bZEUgqVI

Administratum

too true;

'..Administratum

Physicists at Harwell have discovered the heaviest element known to science, named Administratum. The new element has no protons or electrons, and has an atomic number of zero. However, it does have one neutron, eight assistant neutrons, ten executive neutrons, 35 vice neutrons and 258 assistant vice neutrons.

Administratum has an atomic mass of 311=, since the neutron is only detectable half of the time. Its 312 particles are held together by a force which involves the continuous exchange of meson-like particles, called morons.

Since it has no electrons, Administratum is completely inert. Nevertheless, its presence can be detected because it impedes every reaction with which it comes into contact. One experiment, which should have lasted only a few days, is still running after 2= years due to the addition of just one milligramme of Administratum.

It is weakly active, and has a normal half-life of approximately six months. After this time, it does not actually decay, but undergoes a metamorphosis in which assistant neutrons, executive neutrons, vice neutrons and assistant vice neutrons exchange places. This almost invariably leads to an increase in atomic weight, hence it is self-sustaining.

Although it occurs widely, Administratum tends to concentrate around large corporations, research laboratories and government departments. It can especially be found in recently re-organised sites, and there is reason to believe that it is heavily involved in the processes of deforestation and global warming.

It should be remembered that Administratum is known to be toxic at all concentrations, and can easily destroy any productive reactions where it is allowed to accumulate. Numerous attempts have been made to determine how Administratum can be controlled to prevent irreversible damage, but results to date are not promising..'

Talent and hiring

fascinating analysis of Talent and hiring employees etc :

http://www.bbc.co.uk/programmes/b08dnkh8